HomeMy WebLinkAboutWiring Permit - Permits #13084-1 - 2 JOHNSON STREET 2/4/2016 Date...........................................
j OF NORT�y,
I o3� �'•� TOWN OF NORTH ANDOVER
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* ;; * PERMIT FOR WIRING
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This certifies that t: �' �
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has permission to pe olrm e N j l,
r' ;rare r= i �.................. ....
wiring in the building of
at .............................. ....................... . ................. . ...........,North Andover,Mass.
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Fee R......................Lic.NOP1,,04 / ,
ELECTRICAL INSPECTOR
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&\ Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINTININK OR TYPE ALL INFORMATION) Date:- ',),- � i- ((r
City or Town of: NORTH ANDOVER To the Inspector of ires:
By this application the undersigned gives notice of his or her intention to perform the electrical work dcscribed below.
Street&Number) S1, 5�,J_ ,i .
Location(Sti 0--e S S
Owner or Tenant "'A �elephone No.
Owner's Address
J MA ,
Is this permit in conjunction with a building permit? Yes ❑ No FA (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead [:] UndgrdF] No.of Meters
New Service Amps Volts OverheadFJ UndgrdE] No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: EAoc-1-C t (1,2A 'k (("L(CLS"
rc,4,A, i'<-,� L v- LcJk V'e,4�`J 6
Completion of the.followingtable may be waived by the Inspector qf Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above o In- R ivo-.-07 Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
—
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No. of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons K.W. No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local El MunIic'*PP 1
El Other
Connection
No. of Dryers Heating Appliances KWSecurity Svstems:*No.of Devices or Equivalent
No. of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail ifdesired,or as required by the Inspector oJ'917res.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE P"" BOND R OTHER 0 (Specify:)
I certify,under the pains and penaldes of perjury,that the information on this application is true and complete.
FIRM NAME: cA C�A, -IV,(,, LIC.NO.:.
Licensee: Signature 1)/V"" uW4,"', LIC.NO.:
(Ifopplicable,enter "exempt"it?the lid hr line.) Bus.Tel.No.:
Address: � 0,�i arise numbe, 61-1J1(:111-,�,, Alt.Tel.No.: 1126- 3)4
*Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)[-I owner El owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $